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For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
What is it?
What is it used for?
What are the side effects?
What else do I need to know?
For Healthcare Professionals
Ma Zi Ren Wan (MZRW) is a traditional Chinese medicine (TCM) formula with a long history of use as a treatment for constipation. Documented in Shang Han Lun (TCM Treatise on Cold-induced Disorders), it consists of six herbs: Huo Ma Ren (Fructus Cannabis), Da Huang (Radix et Rhizoma Rhei), Bai Shao (Radix Paeoniae Alba), Xing Ren (Semen Armeniacae Amarum), Zhi Shi (Fructus Aurantii Immaturus), and Hou Pu (Cortex Magnoliae Officinalis). According to a systematic review, MZRW is the most commonly used herbal formula for constipation in China (1), particularly by elderly patients and women (2) (3). A population-based study reported that it is also among the formulas commonly prescribed to prostate cancer patients in Taiwan (4).
Much of available data of MZRW’s clinical effects are limited to Asian population. In a three-armed, randomized controlled trial involving patients with functional constipation, MZRW was found to be equally effective as senna, a popular herbal laxative, in increasing complete spontaneous bowel movement (CSBM). Compared to the senna and placebo groups, the MZRW arm also had significant increase in colonic transit along with decreased severity in straining, constipation, incomplete evacuation and global constipation symptoms. The benefits were more durable as well in the MZRW group (5). Similar improvements were reported in another randomized, double-blind study. Patients who took MZRW had increased CSBM, and reductions in constipation severity and the use of rescue therapy compared to the placebo group (6).
A systematic review and meta-analysis (17 trials, 1681 patients) concluded that MZRW is beneficial against functional constipation in Asian population. In addition, MZRW did not increase adverse events compared to the controls (7). Of note, four studies in this review involved pediatric (8) (9); and adult cancer patients with chemo-induced (10) and opioid-associated (11) constipation.
More well-designed trials are needed to strengthen the evidence base surrounding MZRW. Methodologically robust studies are also warranted to determine its potential in relieving non-functional constipation, as well as effectiveness in diverse populations.
Mechanism of Action
The mechanisms of action via which MZRW exerts its effects are not fully known. Findings to date suggest that its components – Fructus Immaturus Citri Aurantii (Zhi Shi), Semen Cannabis Sativae (Ma Zi Ren, also known as Huo Ma Ren) and Semen Pruni Armeniacae (Xing Ren) – may soften stool, reduce water absorption, activate intestinal mucosa, and reestablish gastrointestinal homeostasis to strengthen colonic motility and alleviate constipation. Treatment with MZRW has also been associated with decreased levels of circulating oleamide, a known regulator of intestinal motility (12) (13).